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General NPI Number Information
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NPI Number | 1972874139
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Entity Type | Organization
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Legal Business Name | GENESIS REHAB SERVICES
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 1465 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-4854
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Country | US
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Telephone | 813-655-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 911 KNIGHT ST
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City | SEFFNER
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State | FL
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Zip | 33584-3928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST REGISTERED
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Name | ERIC GRECCO
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Credential |
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Telephone | 813-293-1456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | OT14842
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License Number State | FL
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